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Statin use and risk of new-onset diabetes: A meta-analysis of observational studies.

Abstract

BACKGROUND AND AIMS

Meta-analyses of randomized control trials investigating the association between incident diabetes and statin use showed an increased risk of new-onset diabetes (NOD) from 9% to 13% associated with statins. However, short follow-up period, unpowered sample size, and lack of pre-specified diagnostic criteria for diabetes detection could be responsible of an underestimation of this risk. We conducted a meta-analysis of published observational studies to evaluate the association between statins use and risk of NOD.

METHODS AND RESULTS

PubMed, EMBASE and MEDLINE databases were searched from inception to June 30, 2016 for cohort and case-control studies with risk of NOD in users vs nonusers, on ≥1000 subjects followed-up for ≥1 year. Two review authors assessed study eligibility and risk of bias and undertook data extraction independently. Pooled estimates were calculated by a random-effects model and between-study heterogeneity was tested and measured by I2 index. Furthermore, stratified analyses and the evaluation of publication bias were performed. Finally, the meta-analysis included 20 studies, 18 cohort and 2 case-control studies. Overall, NOD risk was higher in statin users than nonusers (RR 1.44; 95% CI 1.31-1.58). High between-study heterogeneity (I2 = 97%) was found. Estimates for all single statins showed a class effect, from rosuvastatin (RR 1.61; 1.30-1.98) to simvastatin (RR 1.38; 1.19-1.61).

CONCLUSIONS

The present meta-analysis confirms and reinforces the evidence of a diabetogenic effect by statins utilization. These observations confirm the need of a rigorous monitoring of patients taking statins, in particular pre-diabetic patients or patients presenting with established risk factors for diabetes.

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  • Authors+Show Affiliations

    ,

    Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy. Electronic address: sefap@unimi.it.

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    Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy.

    ,

    Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy.

    ,

    Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy.

    ,

    Center for the Study of Atherosclerosis, E. Bassini Hospital, Via M. Gorki 50, Cinisello Balsamo, 20092, Milan, Italy.

    ,

    Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy.

    Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy; IRCCS MultiMedica, Via Milanese 300, 20099, Sesto S. Giovanni (MI), Italy.

    Source

    MeSH

    Biomarkers
    Blood Glucose
    Diabetes Mellitus
    Dyslipidemias
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Lipids
    Observational Studies as Topic
    Odds Ratio
    Risk Assessment
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    28416099

    Citation

    Casula, M, et al. "Statin Use and Risk of New-onset Diabetes: a Meta-analysis of Observational Studies." Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, vol. 27, no. 5, 2017, pp. 396-406.
    Casula M, Mozzanica F, Scotti L, et al. Statin use and risk of new-onset diabetes: A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis. 2017;27(5):396-406.
    Casula, M., Mozzanica, F., Scotti, L., Tragni, E., Pirillo, A., Corrao, G., & Catapano, A. L. (2017). Statin use and risk of new-onset diabetes: A meta-analysis of observational studies. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 27(5), pp. 396-406. doi:10.1016/j.numecd.2017.03.001.
    Casula M, et al. Statin Use and Risk of New-onset Diabetes: a Meta-analysis of Observational Studies. Nutr Metab Cardiovasc Dis. 2017;27(5):396-406. PubMed PMID: 28416099.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Statin use and risk of new-onset diabetes: A meta-analysis of observational studies. AU - Casula,M, AU - Mozzanica,F, AU - Scotti,L, AU - Tragni,E, AU - Pirillo,A, AU - Corrao,G, AU - Catapano,A L, Y1 - 2017/03/10/ PY - 2016/11/08/received PY - 2017/01/11/revised PY - 2017/03/02/accepted PY - 2017/4/19/pubmed PY - 2017/9/7/medline PY - 2017/4/19/entrez KW - Incident diabetes KW - Meta-analysis KW - Observational studies KW - Statins SP - 396 EP - 406 JF - Nutrition, metabolism, and cardiovascular diseases : NMCD JO - Nutr Metab Cardiovasc Dis VL - 27 IS - 5 N2 - BACKGROUND AND AIMS: Meta-analyses of randomized control trials investigating the association between incident diabetes and statin use showed an increased risk of new-onset diabetes (NOD) from 9% to 13% associated with statins. However, short follow-up period, unpowered sample size, and lack of pre-specified diagnostic criteria for diabetes detection could be responsible of an underestimation of this risk. We conducted a meta-analysis of published observational studies to evaluate the association between statins use and risk of NOD. METHODS AND RESULTS: PubMed, EMBASE and MEDLINE databases were searched from inception to June 30, 2016 for cohort and case-control studies with risk of NOD in users vs nonusers, on ≥1000 subjects followed-up for ≥1 year. Two review authors assessed study eligibility and risk of bias and undertook data extraction independently. Pooled estimates were calculated by a random-effects model and between-study heterogeneity was tested and measured by I2 index. Furthermore, stratified analyses and the evaluation of publication bias were performed. Finally, the meta-analysis included 20 studies, 18 cohort and 2 case-control studies. Overall, NOD risk was higher in statin users than nonusers (RR 1.44; 95% CI 1.31-1.58). High between-study heterogeneity (I2 = 97%) was found. Estimates for all single statins showed a class effect, from rosuvastatin (RR 1.61; 1.30-1.98) to simvastatin (RR 1.38; 1.19-1.61). CONCLUSIONS: The present meta-analysis confirms and reinforces the evidence of a diabetogenic effect by statins utilization. These observations confirm the need of a rigorous monitoring of patients taking statins, in particular pre-diabetic patients or patients presenting with established risk factors for diabetes. SN - 1590-3729 UR - https://www.unboundmedicine.com/medline/citation/28416099/Statin_use_and_risk_of_new_onset_diabetes:_A_meta_analysis_of_observational_studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0939-4753(17)30043-1 DB - PRIME DP - Unbound Medicine ER -